A former oncology floor is now used for critically ill COVID-19 patients. In some rooms, patients are doubled up. Non-clinical staff and volunteers are helping out however they can — answering phones, cleaning beds — to help a shorthanded staff.
Though Northeast Georgia Health System is full to the brim with patients, it will never turn anyone away from the emergency department, said Angela Gary, executive director of trauma and emergency nursing services. The unprecedented volume of patients is because a high rate of COVID-19 patients are coming along with non-COVID patients who are no longer as hesitant to come to the hospital, Gary said.
During the previous peak in January when the hospital had as many as 355 COVID-19 positive patients, the emergency department’s volume was down 25-30%, Gary said. When Gary spoke Monday, Aug. 30, there were 284 COVID-19 positive patients in the hospital, but the non-COVID volume is back to a normal level. The Northeast Georgia Medical Center in Gainesville often has a full ambulance bay, sometimes with several trucks lined up behind the five designated unloading spots.
Staff is strained to match demand. Last weekend, the health system’s CEO Carol Burrell asked staff to stretch their normal hours and fill in different roles to manage the influx of patients. Their staff stepped up and filled all 170 positions needed each day, Elizabeth Larkins, executive director of medical nursing services, said Monday, Aug. 30, during a media tour of the medical center.
Larkins has helped convert unusual spaces to be ready for patients in critical condition. The fifth floor of the Gainesville campus’s North Tower was used for oncology treatment until April 2020 when it was converted into an intensive care unit. Health system officials expected to need it for only a few months, but it is still in use — 34 beds filled with COVID-19 positive patients.
Its hallways are narrower than a normal ICU would be, Larkins said, which is exacerbated by crowding from equipment, carts and A/C units lining the halls.
Under normal circumstances, the number of patients would occupy a space three times as big, she said. Monday morning there were five critically ill patients waiting for beds at the medical center and Larkins helped create eight new rooms in other areas of the medical center, she said.
“It is not remotely set up to be an ICU, but we’ve done the best we can with the space to meet the needs of our community for critical care,” she said. “There’s nowhere to be to not be in the way. That’s the truth about being up here.”
Negative pressure machines on the floor help ventilate the space and mitigate against COVID-19 circulating, but it also takes out all the normal air conditioning, Larkins said. To solve this, they installed several A/C units, pumping air into the halls to keep workers from overheating, and they’ll likely still need those units in the winter, she said. They also installed windows in all patient room doors so nurses could check in without having to put on full PPE.
About 80% of the nurses on the floor are travel nurses, and the health system is still seeking to hire more staff.
Volunteers have come to answer phones when family members want updates on a loved one’s condition, which allows nurses to spend more time with patients, Larkins said.
Gov. Brian Kemp recently enlisted National Guard soldiers to help with hospital staffing across the state. John Delzell, the health system’s incident commander, wrote in a statement the hospital has 24 National Guard soldiers between the Gainesville and Braselton campuses as of Tuesday, Aug. 31. The health system has requested 62 more soldiers but has not heard back on whether the request can be fulfilled, Delzell wrote.
The influx of patients has created a strain on supplies as well.
“[Kemp] has previously supported our need for beds, our continued need for staffing, and now our need for timely and dependable shipment of oxygen and all the supplies we need to care for patients,” Delzell wrote. “Our increased numbers of patients have put an increased demand on supply — and that’s the same across the state. That increased demand requires more frequent deliveries and we know how challenging that can be for our suppliers. The governor’s action will help the suppliers, the hospitals and ultimately the patients.”
There are ways the health system tries to support staff’s mental wellbeing during overwhelming days. Gili, a large, fluffy dog, spends time with nurses, as do musicians — normally designated for patients — who play guitar, keyboard or harp. They also have designated “rejuvenation rooms” with massage chairs.
But physicians and nurses who have endured the entire pandemic are overwhelmed anew. One critical care physician, Erine Raybon-Rojas, said she was never convinced the fall would be normal after COVID-19 cases dropped in the spring and summer.
“I knew our vaccination rate was not high,” Raybon-Rojas said. “I think everyone in critical care … knew this was coming because of how many people are unvaccinated and not social distancing and not wearing masks.”
Hall County’s vaccination rate as of Tuesday, Aug. 31, is 39%, and 45% have received at least one dose of a COVID-19 vaccine.
Raybon-Rojas has seen family members side by side in the ICU. In one case, she could not get immediate consent for a patient’s procedure because the rest of their family was in the hospital. One patient told her they still believed COVID-19 was a hoax before she gave them a breathing tube.
“My response is, “‘Do you want me to save your life or not?’” she said. “I just want to do what’s best for them in that moment.”
Whatever people’s beliefs are about COVID-19, the effect of the virus pulses through the rest of the health system, Raybon-Rojas said.
“People who need a CAT scan or biopsy or treatment for cancer or heart problems, all of those things are going to be directly affected by the fact that we are using all of our health care resources, including our providers, to treat this fourth wave,” she said.
As of Tuesday morning, Aug. 31, there were 288 COVID-19 positive patients in the health system and ventilator use is higher than it has been at any point since the health system started tracking the data with 72% of ventilators in use. And 95% of critical care patients are unvaccinated.
The health system is creating as much space for patients as it can before it expects the latest surge to peak in mid-September. And the September peak is expected to be higher than in January, officials said. Physicians and nurses have had to care for patients in hallways and in ambulances during this surge.
The Gainesville and Braselton campuses have outdoor tents set up to treat patients. The Gainesville tent fits 20 patients, and a mobile outdoor unit can also take 20, said Mohak Davé, medical director for the emergency department. The ambulance volume is currently similar to January levels, Davé said.
Many unvaccinated patients have told him that they were waiting for full FDA approval of the vaccine before getting it, he said. But personal stories may have a bigger effect on people’s willingness to get vaccinated, he said.
“Really what’s been helpful has been, unfortunately, ill patients that a lot of people know in the unvaccinated community are taking that story to their family and their friends,” Davé said. “I think that has resonated more.”
A previous version of this article misspelled the name of a dog that visits the staff. The dog's name is Gili.